2001 Conference

THE ANTENATAL SCREENING AND PREVENTION OF POST-NATAL DEPRESSION: A FEASIBLE OR USEFUL GOAL?

Dr Marie-Paule Austin & Professor Judith Lumley

Dr Marie-Paule Austin: MD, FRANZCP, MBBS, Dept Liaison Psychiatry
Prince of Wales Hospital, Randwick, 2031.
Phone: 02 93822796; fax 02 93822177; m.austin@unsw.edu.au

Aims

to review the efficacy of antenatal interventions aimed at reducing post-natal psychological morbidity and post-natal depression (PND).

Methods

Medline, Psylit and CINHAL searches were performed from 1960 to December 2,000; for those intervention studies that remain as yet unpublished, contact was made directly with the researchers involved. Nine antenatal intervention studies (3-4 not as yet published and thus with limited data available), are reported.

Results

Antenatal intervention studies using a predominantly psychoeducational approach are few and so far appear to be unsuccessful. They suffer from a number of limitations including very small numbers, large drop-out rates, lack of adequate antenatal screening tools for identification of those "at risk" leading to the targetting of heterogeneous "at risk" samples; lack of true randomisation and lack of evaluation of the intervention. Furthermore, the majority of interventions were "educational" or supportive in approach rather than following a particular therapeutic paradigm.

The best & largest study, by Brugha et al (2,000), using a structured and well evaluated intervention, showed no difference between the 2 groups. However they also failed to use a validated screening tool, had >50% drop-out rate and given this drop-out rate used insufficient numbers per cell.

Conclusions

At this stage, there is no evidence to show that antenatal interventions in "at risk" samples are useful; however the studies reviewed are far from methodologically pristine. We argue for further studies addressing those methodological limitations before a final conclusion can be reached.